Pub Date : 2025-02-01DOI: 10.1016/j.jpag.2024.07.008
Samuel Soares Coutinho BM , Luana Darc de Menezes Braga BM , Mylena Evilyn Sousa Costa BM , Mariana Oliveira Veloso BM , Ana Paula Negreiros Nunes Alves PhD , Edmar Maciel Lima Júnior MSc , Zenilda Vieira Bruno PhD , Manoel Odorico de Moraes Filho PhD , Carlos Roberto Koscky Paier PhD , Felipe Augusto Rocha Rodrigues PhD , Leonardo Robson Pinheiro Sobreira Bezerra PhD
Background
Gonadal dysgenesis, a genetic condition characterized by incomplete of defective formation of the gonads, can present with vaginal agenesis in individuals with 46, XY karyotype.
Case
We report an innovative intervention in the management of vaginal agenesis in a 19-year-old female with gonadal dysgenesis. Despite initial attempts with vaginal dilators, the patient presented unresponsive, leading to the adoption of a neovaginoplasty using Nile Tilapia Fish Skin (NTFS) as graft. The procedure, based on the McIndoe technique, involved the creation of a 10 cm x 3 cm vaginal canal with an NTFS-wrapped acrylic mold without complications.
Conclusion
The use of NTFS as a graft for neovaginoplasty in gonadal dysgenesis, a novel approach not previously reported in medical literature for this diagnosis, demonstrated favorable outcomes in terms of functionality and patient well-being.
{"title":"Neovaginoplasty With Nile Tilapia Skin Graft in A Patient With Gonadal Dysgenesis: A Case Report","authors":"Samuel Soares Coutinho BM , Luana Darc de Menezes Braga BM , Mylena Evilyn Sousa Costa BM , Mariana Oliveira Veloso BM , Ana Paula Negreiros Nunes Alves PhD , Edmar Maciel Lima Júnior MSc , Zenilda Vieira Bruno PhD , Manoel Odorico de Moraes Filho PhD , Carlos Roberto Koscky Paier PhD , Felipe Augusto Rocha Rodrigues PhD , Leonardo Robson Pinheiro Sobreira Bezerra PhD","doi":"10.1016/j.jpag.2024.07.008","DOIUrl":"10.1016/j.jpag.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Gonadal dysgenesis, a genetic condition characterized by incomplete of defective formation of the gonads, can present with vaginal agenesis in individuals with 46, XY karyotype.</div></div><div><h3>Case</h3><div>We report an innovative intervention in the management of vaginal agenesis in a 19-year-old female with gonadal dysgenesis. Despite initial attempts with vaginal dilators, the patient presented unresponsive, leading to the adoption of a neovaginoplasty using Nile Tilapia Fish Skin (NTFS) as graft. The procedure, based on the McIndoe technique, involved the creation of a 10 cm x 3 cm vaginal canal with an NTFS-wrapped acrylic mold without complications.</div></div><div><h3>Conclusion</h3><div>The use of NTFS as a graft for neovaginoplasty in gonadal dysgenesis, a novel approach not previously reported in medical literature for this diagnosis, demonstrated favorable outcomes in terms of functionality and patient well-being.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 1","pages":"Pages 93-97"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jpag.2024.07.006
Heather Appelbaum MD, FACOG
Minimally invasive surgery (MIS) techniques, including vaginoscopy, laparoscopy, and robotic-assisted surgery, have revolutionized the field of gynecology, offering numerous benefits, such as reduced postoperative pain, shorter hospital stays, and faster recovery. Although these techniques are widely employed in adult gynecologic surgery, their application in pediatric and adolescent patients requires careful consideration due to anatomic differences, patient size, and specific surgical requirements in children. Various aspects of MIS in pediatric and adolescent gynecology, including patient positioning, laparoscopic and robotic instrument choices, trocar placement, surgical techniques, and perioperative pediatric adaptations to MIS, are discussed. The findings highlight the unique challenges and opportunities in performing MIS for pediatric and adolescent patients undergoing gynecologic surgery, emphasizing the need for specialized training and multidisciplinary collaboration.
微创手术（MIS）技术，包括阴道镜、腹腔镜和机器人辅助手术（RAS），为妇科领域带来了革命性的变化，具有减少术后疼痛、缩短住院时间和加快康复等诸多优点。虽然这些技术被广泛应用于成人妇科手术，但由于解剖学差异、患者体型以及儿童的特殊手术要求，在儿童和青少年患者中应用这些技术还需慎重考虑。本文讨论了 MIS 在小儿和青少年妇科中的各个方面，包括患者定位、腹腔镜和机器人器械的选择、套管放置、手术技巧以及围手术期小儿对 MIS 的适应性。研究结果突显了为接受妇科手术的儿童和青少年患者实施 MIS 所面临的独特挑战和机遇，强调了专业培训和多学科合作的必要性。
{"title":"Perioperative and Operative Considerations for Minimally Invasive Surgery in Pediatric and Adolescent Gynecology","authors":"Heather Appelbaum MD, FACOG","doi":"10.1016/j.jpag.2024.07.006","DOIUrl":"10.1016/j.jpag.2024.07.006","url":null,"abstract":"<div><div>Minimally invasive surgery (MIS) techniques, including vaginoscopy, laparoscopy, and robotic-assisted surgery, have revolutionized the field of gynecology, offering numerous benefits, such as reduced postoperative pain, shorter hospital stays, and faster recovery. Although these techniques are widely employed in adult gynecologic surgery, their application in pediatric and adolescent patients requires careful consideration due to anatomic differences, patient size, and specific surgical requirements in children. Various aspects of MIS in pediatric and adolescent gynecology, including patient positioning, laparoscopic and robotic instrument choices, trocar placement, surgical techniques, and perioperative pediatric adaptations to MIS, are discussed. The findings highlight the unique challenges and opportunities in performing MIS for pediatric and adolescent patients undergoing gynecologic surgery, emphasizing the need for specialized training and multidisciplinary collaboration.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 1","pages":"Pages 18-25"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jpag.2024.09.001
Shruthi Srinivas MD, MPH , Jenna Wilson BS , Katherine C. Bergus MD, MPH , Chelsea Kebodeaux MD , Kate McCracken MD , Richard J. Wood MD , Geri Hewitt MD
Objective
Patients with anorectal malformations (ARMs) may have concurrent gynecologic abnormalities. As patients grow, they typically transition from pediatric subspeciality care and seek adult obstetrics and gynecology (OB/GYN)-related services. We aimed to assess adult OB/GYN physicians’ knowledge, competency, and comfort regarding meeting the sexual and reproductive health care needs of patients with ARMs.
Methods
We performed a cross-sectional observational survey-based study of graduates from a single academic OB/GYN residency program from 2013 to 2022. Physicians were surveyed on experience, comfort, and challenges with caring for patients with ARMs and given a knowledge assessment. Descriptive and comparative statistics between those who did and did not complete a Pediatric and Adolescent Gynecology (PAG) rotation were generated.
Results
There were 59 respondents (53.6%). Fewer than half (39.0%) reported caring for a patient with an ARM, an appendicovesicostomy (12.3%), or an appendicostomy (5.4%). Most felt uncomfortable (80.4%) or felt they lacked competence in caring for these patients (81.8%). Most (64.3%) felt that ARMs should be discussed in residency. Only 1 physician (1.7%) answered all questions in the knowledge assessment correctly; 33.9% did not answer any question correctly. On subgroup analysis, more physicians who had completed a pediatric and adolescent gynecology rotation recalled learning about ARMs (83.3% vs 51.9%, P = .03); however, there were no differences in experience, comfort, competence, or willingness to learn.
Conclusion
OB/GYN providers report a lack of knowledge and comfort in caring for patients with ARMs. Development of a standardized OB/GYN residency curriculum and education for practicing OB/GYN physicians is necessary to allow access to knowledgeable sexual and reproductive health for this patient population.
目的：肛门直肠畸形（ARM）患者可能同时伴有妇科异常。随着患者的成长，他们通常会从儿科亚专科护理过渡到寻求成人妇产科相关服务。我们的目的是评估成人妇产科医生在满足 ARM 患者的性健康和生殖健康护理需求方面的知识、能力和舒适度：方法：我们对 2013-2022 年间来自单一学术性妇产科住院医师培训项目的毕业生进行了一项横断面观察调查研究。我们调查了医生在护理 ARM 患者方面的经验、舒适度和挑战，并对他们进行了知识评估。对完成和未完成儿科和青少年妇科（PAG）轮转的医生进行了描述性和比较性统计：共有 59 名受访者（53.6%）。只有不到一半的受访者（39.0%）表示护理过患有 ARM、阑尾切除术（12.3%）或阑尾造口术（5.4%）的患者。大多数人在护理这些病人时感到不舒服（80.4%）或觉得自己缺乏能力（81.8%）。大多数人（64.3%）认为应在住院医师培训中讨论 ARM。只有一名医生（1.7%）正确回答了知识评估中的所有问题；33.9%的医生没有正确回答任何问题。在分组分析中，更多完成 PAG 轮转的医生回忆起学习过 ARMs（83.3 vs 51.9%，P=0.03）；但在经验、舒适度、能力或学习意愿方面没有差异：结论：妇产科医护人员在护理 ARM 患者方面缺乏知识和舒适感。有必要制定标准化的妇产科住院医师课程并对妇产科执业医师进行教育，使这一患者群体能够获得性健康和生殖健康方面的知识。
{"title":"Adult Obstetricians and Gynecologists Lack Knowledge of Anorectal Malformations—A Call for Action","authors":"Shruthi Srinivas MD, MPH , Jenna Wilson BS , Katherine C. Bergus MD, MPH , Chelsea Kebodeaux MD , Kate McCracken MD , Richard J. Wood MD , Geri Hewitt MD","doi":"10.1016/j.jpag.2024.09.001","DOIUrl":"10.1016/j.jpag.2024.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with anorectal malformations (ARMs) may have concurrent gynecologic abnormalities. As patients grow, they typically transition from pediatric subspeciality care and seek adult obstetrics and gynecology (OB/GYN)-related services. We aimed to assess adult OB/GYN physicians’ knowledge, competency, and comfort regarding meeting the sexual and reproductive health care needs of patients with ARMs.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional observational survey-based study of graduates from a single academic OB/GYN residency program from 2013 to 2022. Physicians were surveyed on experience, comfort, and challenges with caring for patients with ARMs and given a knowledge assessment. Descriptive and comparative statistics between those who did and did not complete a Pediatric and Adolescent Gynecology (PAG) rotation were generated.</div></div><div><h3>Results</h3><div>There were 59 respondents (53.6%). Fewer than half (39.0%) reported caring for a patient with an ARM, an appendicovesicostomy (12.3%), or an appendicostomy (5.4%). Most felt uncomfortable (80.4%) or felt they lacked competence in caring for these patients (81.8%). Most (64.3%) felt that ARMs should be discussed in residency. Only 1 physician (1.7%) answered all questions in the knowledge assessment correctly; 33.9% did not answer any question correctly. On subgroup analysis, more physicians who had completed a pediatric and adolescent gynecology rotation recalled learning about ARMs (83.3% vs 51.9%, <em>P</em> = .03); however, there were no differences in experience, comfort, competence, or willingness to learn.</div></div><div><h3>Conclusion</h3><div>OB/GYN providers report a lack of knowledge and comfort in caring for patients with ARMs. Development of a standardized OB/GYN residency curriculum and education for practicing OB/GYN physicians is necessary to allow access to knowledgeable sexual and reproductive health for this patient population.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 1","pages":"Pages 68-74"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jpag.2024.09.005
Caroline L Katzman MD , Jessica C Sims MD , Julen N Harris MD, MPH , Susan L Rosenthal PhD , Jenny KR Francis MD, MPH
Study Objective
In an increasing number of states, parents must provide permission for their daughters under 18-years-old to start contraception. We sought to understand perceptions among mother-daughter dyads about sources of information, and to describe dyadic interactions when discussing contraception.
Methods
Dyads were recruited from an adolescent medicine clinic in Dallas, TX. A semistructured joint interview was conducted with each dyad. Interviews were recorded, transcribed, and coded through an iterative approach.
Results
There were 11 dyadic interviews (22 participants). Sources of information about contraception included mothers, healthcare providers (HCPs), friends/family, school, and individualized learning. Dyads identified distinct purposes and limitations of each source. Mothers noted the importance of supporting their daughter's development and specific needs. Often these conversations began with a discussion of menstrual management. Information from friends/family was overwhelmingly anecdotal. Schools and HCPs were viewed as trusted sources, and the internet/social media as possibly inaccurate or misleading. Dyads described several risks and benefits of different methods. Minimal conflict was noted.
Conclusion
These results provide rich information about how mother-daughter dyads view contraception in joint discussion. It is important to ensure that accurate stories about contraception are accessible and teaching health literacy would be helpful. Menstrual management appears to be an acceptable starting point to discuss contraception. Schools and HCPs are trusted sources and measures should be taken to ensure teaching is accurate, developmentally appropriate and teaches evaluation of online information. Regardless of parental consent laws for adolescent contraception, engaging caregivers in the process can help support adolescent contraceptive decision-making.
{"title":"Mother-Daughter Dyads’ Perceptions of Contraception","authors":"Caroline L Katzman MD , Jessica C Sims MD , Julen N Harris MD, MPH , Susan L Rosenthal PhD , Jenny KR Francis MD, MPH","doi":"10.1016/j.jpag.2024.09.005","DOIUrl":"10.1016/j.jpag.2024.09.005","url":null,"abstract":"<div><h3>Study Objective</h3><div>In an increasing number of states, parents must provide permission for their daughters under 18-years-old to start contraception. We sought to understand perceptions among mother-daughter dyads about sources of information, and to describe dyadic interactions when discussing contraception.</div></div><div><h3>Methods</h3><div>Dyads were recruited from an adolescent medicine clinic in Dallas, TX. A semistructured joint interview was conducted with each dyad. Interviews were recorded, transcribed, and coded through an iterative approach.</div></div><div><h3>Results</h3><div>There were 11 dyadic interviews (22 participants). Sources of information about contraception included mothers, healthcare providers (HCPs), friends/family, school, and individualized learning. Dyads identified distinct purposes and limitations of each source. Mothers noted the importance of supporting their daughter's development and specific needs. Often these conversations began with a discussion of menstrual management. Information from friends/family was overwhelmingly anecdotal. Schools and HCPs were viewed as trusted sources, and the internet/social media as possibly inaccurate or misleading. Dyads described several risks and benefits of different methods. Minimal conflict was noted.</div></div><div><h3>Conclusion</h3><div>These results provide rich information about how mother-daughter dyads view contraception in joint discussion. It is important to ensure that accurate stories about contraception are accessible and teaching health literacy would be helpful. Menstrual management appears to be an acceptable starting point to discuss contraception. Schools and HCPs are trusted sources and measures should be taken to ensure teaching is accurate, developmentally appropriate and teaches evaluation of online information. Regardless of parental consent laws for adolescent contraception, engaging caregivers in the process can help support adolescent contraceptive decision-making.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 1","pages":"Pages 79-84"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jpag.2024.09.002
Areej Hassan MD, MPH , Sarah Golub MD, MPH
Today, it is globally recognized that sexual and reproductive health is a human rights issue critical to economic growth and stability, ending poverty, and fostering sustainable development. Calls for improving sexual and reproductive health, including a spotlight on adolescents and young women, are highlighted in the Sustainable Development Goals (SDG) adopted by the United Nations in 2015. In this commentary, we aim to (1) briefly review the history and objectives of global development goals, (2) review the adolescent health-related Sustainable Development Goal targets and indicators with a focus on sexual and reproductive health, (3) discuss global progress and challenges in achieving target measures, and (4) examine action steps that clinicians can take to accelerate progress.
{"title":"Sexual and Reproductive Health Goals and the 2030 Global Agenda for Sustainable Development: Progress, Prospects, and Challenges","authors":"Areej Hassan MD, MPH , Sarah Golub MD, MPH","doi":"10.1016/j.jpag.2024.09.002","DOIUrl":"10.1016/j.jpag.2024.09.002","url":null,"abstract":"<div><div>Today, it is globally recognized that sexual and reproductive health is a human rights issue critical to economic growth and stability, ending poverty, and fostering sustainable development. Calls for improving sexual and reproductive health, including a spotlight on adolescents and young women, are highlighted in the Sustainable Development Goals (SDG) adopted by the United Nations in 2015. In this commentary, we aim to (1) briefly review the history and objectives of global development goals, (2) review the adolescent health-related Sustainable Development Goal targets and indicators with a focus on sexual and reproductive health, (3) discuss global progress and challenges in achieving target measures, and (4) examine action steps that clinicians can take to accelerate progress.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 1","pages":"Pages 13-17"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We aim to evaluate the long-term outcomes of ovarian preserving surgery for neonatal ovarian cysts.
Method
The clinical data of neonatal ovarian cysts treated in our hospital from January 2015 to December 2022 were retrospectively analyzed.
Results
Our study included 22 patients, of which 21 were unilateral and 1 was bilateral. There were 13 cases of simple cysts and 9 cases of complex cysts, and one cyst changed from simple to complex. The mean largest diameter of simple cysts was 5.7 ± 2.1 cm, and that of complex cysts was 4.6 ± 2.0 cm. There was no significant difference between the two groups (P = .2264). Among the 22 patients, 21 underwent laparoscopic cystectomy. The only patient with bilateral cysts underwent percutaneous drainage of the right simple cyst. Twenty-one histological specimens were reviewed, of which 18 (85.7%) contained viable ovarian tissues. Five cases lost follow-up after surgery, and the remaining 17 cases had a follow-up period of 6 months to 5 years. The last ultrasound follow-up showed that 9 cases had bilateral normal ovaries, and 8 cases lost the ipsilateral ovary. The ovarian preservation rate of simple cyst was 90% (9/10), which was significantly higher than that of complex cyst (12.5%, 1/8) (P = .003).
Conclusions
Simple cysts (≥4 cm) had an excellent prognosis, with a long-term ovarian preservation rate of 90%. The long-term ovarian preservation rate of complex cysts after surgery was relatively low. Our study suggested that surgical treatment did not increase the chances of preserving the ovaries of patients with complex cysts.
{"title":"Long-Term Outcomes of Ovary Preserving Procedure for Neonatal Ovarian Cysts","authors":"XiaoLi Chen, DuoTe Cai, Yi Chen, BinBin Yang, YueBin Zhang, QingJiang Chen, ZhiGang Gao","doi":"10.1016/j.jpag.2024.09.007","DOIUrl":"10.1016/j.jpag.2024.09.007","url":null,"abstract":"<div><h3>Objective</h3><div>We aim to evaluate the long-term outcomes of ovarian preserving surgery for neonatal ovarian cysts.</div></div><div><h3>Method</h3><div>The clinical data of neonatal ovarian cysts treated in our hospital from January 2015 to December 2022 were retrospectively analyzed.</div></div><div><h3>Results</h3><div>Our study included 22 patients, of which 21 were unilateral and 1 was bilateral. There were 13 cases of simple cysts and 9 cases of complex cysts, and one cyst changed from simple to complex. The mean largest diameter of simple cysts was 5.7 ± 2.1 cm, and that of complex cysts was 4.6 ± 2.0 cm. There was no significant difference between the two groups (<em>P</em> = .2264). Among the 22 patients, 21 underwent laparoscopic cystectomy. The only patient with bilateral cysts underwent percutaneous drainage of the right simple cyst. Twenty-one histological specimens were reviewed, of which 18 (85.7%) contained viable ovarian tissues. Five cases lost follow-up after surgery, and the remaining 17 cases had a follow-up period of 6 months to 5 years. The last ultrasound follow-up showed that 9 cases had bilateral normal ovaries, and 8 cases lost the ipsilateral ovary. The ovarian preservation rate of simple cyst was 90% (9/10), which was significantly higher than that of complex cyst (12.5%, 1/8) (<em>P</em> = .003).</div></div><div><h3>Conclusions</h3><div>Simple cysts (≥4 cm) had an excellent prognosis, with a long-term ovarian preservation rate of 90%. The long-term ovarian preservation rate of complex cysts after surgery was relatively low. Our study suggested that surgical treatment did not increase the chances of preserving the ovaries of patients with complex cysts.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 1","pages":"Pages 35-38"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jpag.2024.10.005
Jessica Y. Shim MD , Carly E. Milliren MPH , Amy D. DiVasta MD, MMSc
Study Objective
To estimate the 1-year continuation rate of the levonorgestrel-releasing intrauterine device (LNG-IUD) in adolescents with endometriosis, and the frequency at which additional systemic hormonal treatment (HT) is utilized.
Methods
A retrospective cohort study was performed of patients aged 12-21 years who underwent laparoscopy for endometriosis and LNG-IUD insertion at a single tertiary care institution between 2018 and 2021.
Results
We evaluated 224 adolescents (mean age = 17.0, SD = 1.8 years) who underwent LNG-IUD placement during laparoscopic evaluation for endometriosis. Stage I endometriosis was most common (84.4%), followed by stage II (13.0%). Of 221 with follow-up, 208 (94.1%) had HT added or continued postsurgery. The most common additional HT was norethindrone acetate (42.5%), followed by combined hormonal contraceptives (34.8%). The 1-year LNG-IUD continuation rate was 92.0%. There were 18 IUD removals (8%) by 1 year, and the median time to removal was 118 days (interquartile range = 159; range 8-293). Use of additional HT was associated with a lower hazard of IUD removal within the first year of use (hazard ratio = 0.19, 95% confidence interval: 0.06-0.56, P < .001).
Conclusion
The majority of adolescents used the LNG-IUD with additional systemic HT for endometriosis management. While overall continuation was high, adolescents who were using LNG-IUD and HT were more likely to continue LNG-IUD than those who were not utilizing additional HT.
{"title":"Continuation of the Levonorgestrel-Releasing Intrauterine Device Among Adolescents With Endometriosis","authors":"Jessica Y. Shim MD , Carly E. Milliren MPH , Amy D. DiVasta MD, MMSc","doi":"10.1016/j.jpag.2024.10.005","DOIUrl":"10.1016/j.jpag.2024.10.005","url":null,"abstract":"<div><h3>Study Objective</h3><div>To estimate the 1-year continuation rate of the levonorgestrel-releasing intrauterine device (LNG-IUD) in adolescents with endometriosis, and the frequency at which additional systemic hormonal treatment (HT) is utilized.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed of patients aged 12-21 years who underwent laparoscopy for endometriosis and LNG-IUD insertion at a single tertiary care institution between 2018 and 2021.</div></div><div><h3>Results</h3><div>We evaluated 224 adolescents (mean age = 17.0, SD = 1.8 years) who underwent LNG-IUD placement during laparoscopic evaluation for endometriosis. Stage I endometriosis was most common (84.4%), followed by stage II (13.0%). Of 221 with follow-up, 208 (94.1%) had HT added or continued postsurgery. The most common additional HT was norethindrone acetate (42.5%), followed by combined hormonal contraceptives (34.8%). The 1-year LNG-IUD continuation rate was 92.0%. There were 18 IUD removals (8%) by 1 year, and the median time to removal was 118 days (interquartile range = 159; range 8-293). Use of additional HT was associated with a lower hazard of IUD removal within the first year of use (hazard ratio = 0.19, 95% confidence interval: 0.06-0.56, <em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>The majority of adolescents used the LNG-IUD with additional systemic HT for endometriosis management. While overall continuation was high, adolescents who were using LNG-IUD and HT were more likely to continue LNG-IUD than those who were not utilizing additional HT.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 1","pages":"Pages 85-88"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This advocacy statement endeavors to clarify the concept of the hymen as a symbol of “virginity.” The anatomic variants of this structure precludes any correlation to prior sexual activity and the value of physical assessment of this structure is thus questioned. Moreover, physical examination of the hymen is painful, traumatic, and humiliating and is a form of gender-based violence. This statement exhorts various sectors—governments, educators, the medical community, and the general public—to discard the concept of the “virgin hymen,” avoid its use when documenting sexual abuse, and provide progressive education to affirm female sexuality.
{"title":"FIGIJ and NASPAG Advocacy Statement-Eliminating the Persistent Misconception of the “Virgin Hymen”","authors":"Judith Celine Simms-Cendan , Angela G. Sison-Aguilar , Mariela Orti , Clara DiNunzio , Anastasia Vatopoulou , Ellen Rome , Michalina Drejza , Jasmin Jayasinghe , Daniela Ivanova Panova , Marisa Labovsky","doi":"10.1016/j.jpag.2024.08.014","DOIUrl":"10.1016/j.jpag.2024.08.014","url":null,"abstract":"<div><div>This advocacy statement endeavors to clarify the concept of the hymen as a symbol of “virginity.” The anatomic variants of this structure precludes any correlation to prior sexual activity and the value of physical assessment of this structure is thus questioned. Moreover, physical examination of the hymen is painful, traumatic, and humiliating and is a form of gender-based violence. This statement exhorts various sectors—governments, educators, the medical community, and the general public—to discard the concept of the “virgin hymen,” avoid its use when documenting sexual abuse, and provide progressive education to affirm female sexuality.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 1","pages":"Pages 11-12"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jpag.2024.08.010
Jacquelyn R. Evans DO , Amanda V. French MD
The objective of this document is to provide guidance on the recognition, diagnosis and management of non-sexually acquired genital ulcers in the pediatric and adolescent patient. Commonly known as genital or vulvar aphthous ulcers, lesions are typically seen in the peri‑menarchal population, are exquisitely painful, generally self-limited and managed with supportive care. Details of ulcer physical appearance, proposed etiology and options for management are provided to familiarize clinicians with this entity, which can be alarming for patients and families.
{"title":"NASPAG Clinical Consensus on Nonsexually Acquired Genital Ulcers (Vulvar Aphthous Ulcers)","authors":"Jacquelyn R. Evans DO , Amanda V. French MD","doi":"10.1016/j.jpag.2024.08.010","DOIUrl":"10.1016/j.jpag.2024.08.010","url":null,"abstract":"<div><div>The objective of this document is to provide guidance on the recognition, diagnosis and management of non-sexually acquired genital ulcers in the pediatric and adolescent patient. Commonly known as genital or vulvar aphthous ulcers, lesions are typically seen in the peri‑menarchal population, are exquisitely painful, generally self-limited and managed with supportive care. Details of ulcer physical appearance, proposed etiology and options for management are provided to familiarize clinicians with this entity, which can be alarming for patients and families.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 1","pages":"Pages 4-10"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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